<form id="CDLDSCSurveyForm">
  <style type="text/css">
  /* center the jQuery UI dialog */
  .ui-dialog-title { float:none !important; display: block; text-align: center; 
  font-size: 120%;
}
  /* css for this form */
  #CDLDSCSurveyForm label { display: block; text-align: left; }
  </style>
  <div style="text-align:center;">
    <img 
      src="http://cdn.calisphere.org/data/13030/tr/kt5s2037tr/files/kt5s2037tr-FID_T1.jpg" 
      title="image courtesy of Sourisseau Academy for State and Local History" 
      width="200" height="161"/>
    <!--   width="260" height="208"/> -->
    <p>We are learning more about visitors to this website so we can
    continue to improve it. How would you best describe yourself?</p>
  </div> 
  <div style="margin: 1em 0 1em 1em;">
    <label><input type="radio" name="who" value="k12-teacher-librarian"/>K-12 teacher or librarian</label>
    <label><input type="radio" name="who" value="k12-student"/>K-12 student</label>
    <label><input type="radio" name="who" value="college"/>College student</label>
    <label><input type="radio" name="who" value="grad-student"/>Graduate student</label>
    <label><input type="radio" name="who" value="faculty-researcher"/>Faculty or academic researcher</label>
    <label><input type="radio" name="who" value="genealogist-researcher"/>Genealogist or family researcher</label>
    <label><input type="radio" name="who" value="archivist/librarian"/>Archivist or librarian</label>
    <div style="text-align: left;"><label style="display:inline;"><input type="radio" name="who" value="other" id="CDLDSCPopUpSurveyother"/>Other </label><input name="other" onfocus="$('#CDLDSCPopUpSurveyother')[0].checked=true"/></div>
  </div>

  <div style="text-align:center;">
    <input id="CDL_DSC_PopUpSurvey_submit" type="submit" name="CDL_DSC_PopUpSurvey_submit" value="Submit" 
     style="font-size: 1.5em; height: 1.8em; background-color: #4F81BD; color:#fff; border: solid 3px #385d8a;"
     onclick="CDL.DSC.PopUpSurveySubmit($('#CDLDSCSurveyForm input:checked').val(),$('#CDLDSCSurveyForm input[name=other]').val() ); return false;"/>
    <!-- communication area -->
    <p id="CDLDSCSurveyFormB" style="font-style: italic;">Thank you for your feedback!</p>
  </div>
  <!-- opt out -->
  <div style="font-size: 80%; text-align: left;">
    <a href="#" onclick="$('#CDL_DSC_PopUpSurvey').dialog('close'); return false;">No thanks</a>
  </div>
  <script>
var _gaq = _gaq || [];
  _gaq.push(['cst._setCustomVar', 4, 'survey-2012', 'survey-2012', 3 ]);
  </script>
</form>
